Children’s anesthesia questioned after two cases of severe brain damage

RODEO – Two years before a 13-year-old California girl was left brain-dead following a tonsillectomy, another Children’s Hospital Oakland patient was left with catastrophic brain damage following a common tonsil surgery to treat sleep apnea.

Rebecca Jimenez, of Rodeo, once a smart and vivacious elementary school student, can no longer walk, talk or communicate with her family following her Sept. 6, 2011, elective tonsillectomy and adenoidectomy, the most common surgery with general anesthesia for kids in America.

Rebecca and her parents sued the hospital, its anesthesiology unit, the surgeon and anesthesiologist Dec. 9, 2011, for medical negligence and settled with the latter three for $4.4 million, according to court documents. They reached their final settlement, with the hospital, on Nov. 26, but the amount has not been announced.

Part of the money has been placed into a trust to pay for 24-hour-a-day care for Rebecca, 11, who, unlike Jahi, shows some brain activity.

Different doctors were involved in each girl’s surgeries, although both girls began showing signs of distress in the hospital’s pediatric intensive care unit.

Rebecca’s attorney, Richard Schoenberger, said he has reached out to Jahi’s family to offer assistance any way possible. “It is eerily and sadly reminiscent — startlingly so — to what happened to Rebecca.”

The twin tragedies have raised further questions about the use of tonsillectomies to treat sleep apnea, as well as the level of care at the highly respected East Bay hospital. Should pediatric tonsillectomy patients have second thoughts about Children’s Hospital Oakland?

“I do think it’s unfair to indict a whole hospital, one that is very good at what it does,” he said. “It’s more important to find out how it happened and prevent it from happening again.”

A hospital spokeswoman said the hospital could not comment on pending litigation but released a statement:

“Over the course of its 100 years, Children’s Hospital & Research Center has successfully cared for tens of thousands of children who have had great outcomes. In fact, we have saved countless lives,” Cynthia Chiarappa said. “Unfortunately, as happens in hospitals across the nation with any complicated surgery, there are risks involved, and there are rare circumstances when complications arise. We are sorry that Jahi McMath suffered catastrophic complications and hope that her family can find closure in this sad situation.”

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A judge ruled the hospital can discontinue life support Monday, but Jahi’s family said Thursday it is planning to move Jahi to a long-term care facility in the Bay Area that has agreed to care for her.

The 13-year-old girl underwent what the hospital called a “complicated” surgery Dec. 9 removing her tonsils and other throat and nose tissue, according to the hospital, to treat her severe sleep apnea. She started bleeding shortly after surgery, eventually going into cardiac arrest and losing brain function, according to the results of six doctor examinations.

Her mother claims that nurses in the PICU told her the bleeding was “normal” and left it up to her and Jahi’s grandmother to control the bleeding.

Calls, emails and texts to Jahi’s family and attorney were not returned Thursday, and Schoenberger said Rebecca’s family declined to comment.

Rebecca’s court and medical records raise questions about her post-surgical care. In contrast to Jahi’s surgery, the hospital called Rebecca’s procedure “uncomplicated,” according to the medical records; it did not involve the removal of other throat and nose tissue.

The 8-year-old girl came out of surgery disoriented, with her head slumped sideways, saying over and over “me duele,” Spanish for “it hurts,” according to medical records. Her mother told nurses she looked pale, had cold fingers, and her eyes, when open, were not focused, according to the records included in court documents.

Her mother was told to give Rebecca pain medicine when she returned home, but the mom asked how she could do it if Rebecca was not opening her mouth, so the nurse gave her extra morphine through a drip. When asked by her mom whether she was ready to go home, Rebecca replied “mmm” without moving her head. The girl was loaded onto a wheelchair without the input of the anesthesiologist, according to the settlement documents.

On the drive home, her mother grew concerned when her daughter became extremely pale, with her eyes rolled back in her head, her heart racing, so she called the postoperative hotline from the car, according to the medical records. The parents were reassured and told to call back in five hours if the symptoms did not improve, records show.

Five hours later, the mother brought Rebecca to the emergency room, where doctors realized she was in critical condition. A CAT scan discovered a cerebral and brainstem edema, or severe swelling of the brain, that deprived oxygen to the brain, records show.

“We believed then and we believe now that Rebecca’s condition is such that she should never have been discharged,” Schoenberger said. “Had she not been discharged, she wouldn’t have suffered the fate she did.”

Schoenberger said there are very good doctors and nurses at the hospital but said a “constellation of mistakes” led to Rebecca’s plight.

Now 11, Rebecca is confined to her bed with no voluntary movement in her extremities, and requires a feeding tube. She laughs and smiles in response to being tickled and when listening to cartoons, and cries when the television is turned off, but that is the extent of her reactions, according to a plan prepared for court that estimates her care the rest of her life will cost between $5 million and $10 million.

“She was a delightful, wonderful, smart, beautiful little girl,” Schoenberger said. “She was her parents’ pride and joy, and now she’s a shell of a human being.”

Schoenberger said Rebecca’s family has been touched by Jahi’s story.

“At one point, they were not sure that Rebecca would make it,” he said. “That’s why the family is very sympathetic to this loving family.”